Laringitis

Laryngitis
• The larynx is a complex organ that is important for airway protection

and maintaining safe swallowing and positive pressure in the
pulmonary system.
• Laryngitis describes inflammation of the larynx, and a variety of
causes result in the presentation of common symptoms.
• Typically,laryngitis includes dysphonia, air wasting (excessive loss of
air through the incompletely closed glottis resulting in a breathy
voice), and pain or discomfort in the anterior neck, and it may include
other symptoms such as cough, throat clearing, globus pharyngeus
(feeling of a lump inthe throat), fever, myalgia, and dysphagia
Prevalence
• The prevalence of laryngitis is difficult to estimate. A review
conducted by the Royal College of General Practitioners in the United
Kingdom in 2010 reported an average incidence of 6.6 cases of
laryngitis and tracheitis per 100 000 patients (all ages) per week.
• Laryngeal symptoms may have many causes.
• They are usually driven by four broad disease processes:
inflammation, neoplastic and structural abnormalities, imbalance in
muscle tension, and neuromuscular dysfunction
• Having assessed the airway, the history should cover the nature and
chronology of voice symptoms, any exacerbating and relieving factors,
and the patient’s voice use and requirements.
Box 1 Red flag symptoms for early referral (adapted from Schwartz et al7)
• Stridor—emergency referral
• Recent surgery involving the neck or recurrent laryngeal nerve
• Recent endotracheal intubation
• Radiotherapy to the neck
• History of smoking
• Professional voice user (for example, singer, actor, teacher)
• Weight loss
• Dysphagia or odynophagia
• Otalgia
• Serious underlying concern by clinician
The Causes Of Acute Laryngitis
• Acute laryngitis is commonly caused by infection (viral,bacterial, or
fungal) or trauma. Inflammation and oedema of the larynx impairs
vibration of the vocal folds, with resulting symptoms.
• Viruses are the most common cause of acute laryngitis, most often
rhinovirus, adenovirus, influenza, and parainfluenza.
• Rarely, severe infections such as herpes simplex can result in laryngeal
erosion and necrosis.
Bacterial laryngitis
• Bacteria are also an important cause of acute laryngitis, and
distinction between viral and bacterial infections can be difficult.
• Commonly identified bacteria include Haemophilus influenzae B
(HiB), Streptococcus pneumoniae, Staphylococcus aureus,
βhaemolytic streptococci, Moraxella catarrhalis, and Klebsiella
pneumoniae
• Unusual causes of bacterial laryngitis in developed nations include
mycobacterial and syphilitic disease
Supraglottitis and epiglottitis
• Owing to the rapid progression of airway compromise, especially in
children, much of the literature on acute bacterial laryngitis concerns
supraglottitis and epiglottitis, particularly in the context of H
influenzae.
• Patients present with rapidly progressing odynophagia, dysphagia,
hoarseness, drooling, and stridor.
• Treatment for less severe cases includes humidification through
nebulised normal saline, or constant humidified oxygen,
corticosteroids, intravenous antibiotics, and nebulised adrenaline.
• HiB vaccination has altered the epidemiology and incidence of
supraglottitis and epiglottitis.
Fungal laryngitis
• Laryngeal candidiasis is a common yet under-diagnosed disease,
presenting in both immunocompromised and immunocompetent
patients and accounting for up to 10% of presentations.
• Risk factors include recent use of antibiotics and use of inhaled
corticosteroids.
• Candidiasis may mimic other disorders, particularly hyperkeratosis,
leucoplakia, and malignancy, and these must be ruled out by biopsy
or imaging.
Phonotrauma
• Laryngeal inflammation can arise from collision forces of the vocal
fold
• Yelling, screaming, forceful singing, and strained voicing may result in
diffuse inflammation and erythema within the larynx.
• These may be acute or may persist, with development of chronic
laryngitis.
Management Of Acute Laryngitis
• Management of laryngitis varies depending on the severity.
• Management options include vocal hygiene and antibiotics.
Vocal hygiene :
• Vocal hygiene refers to measures such as voice rest, hydration,
humidification, and limiting caffeine intake.
• Most programmes focus on four main tenets:
- dealing with the amount and type of voice use,
- Reducing phonotraumatic behaviours,
- improving hydration, and
- enhancing lifestyle to improve vocal health, such as reducing caffeine and
alcohol intake, smoking cessation, and managing medical conditions.
Antibiotik
• Treatment of acute laryngitis with antibiotics is widely debated,
• The first included study compared a five day course of penicillin V
with placebo and reported no difference in patient reported
symptoms at 2-6 months’follow-up.
• The second study compared erythromycin with placebo and found a
subjective reduction in voice disturbance at one week and a
reduction in cough at two weeks in the erythromycin group.
chronic laryngitis
• defined as laryngitis that persists beyond three weeks.
• It can be due to a range of different disease processes, ranging from
inflammatory processes, such as allergic laryngitis and
laryngopharyngeal reflux, to autoimmune disorders such as
rheumatoid arthritis, and granulomatous disease such as sarcoidosis.
• Chronic laryngitis is less prevalent in primary practice
Laryngopharyngeal reflux/extraoesophageal
reflux
• Symptoms of laryngopharyngeal reflux include non-specific laryngeal
manifestations, such as hoarseness, dysphagia, odynophagia, globus
pharyngeus, chronic cough, and throat clearing.
• The prevalence of laryngopharyngeal reflux is difficult to determine,
particularly as typical heartburn is absent in 57-94% of patients.
• However, it has been estimated to be present in 10% of patients
presenting to an otolaryngologist and over half the patients referred
with voice disorders.

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Laryngitis

• The larynx is a complex organ that is important for airway protection

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